Ceftizoxime in the treatment of urinary tract infections

Ceftizoxime, a new beta-lactamase-resistant, semisynthetic antibiotic, was compared to cefamandole in a prospective randomized trial to determine its efficacy and safety in 21 patients with acute, complicated urinary tract infections. Four patients randomized initially to receive cefamandole were found to have resistant organisms and were treated with ceftizoxime. Dosage for ceftizoxime was 1 gm. administered parenterally every 12 hours, while 1 gm. cefamandole was given every 6 hours. Urine cultures were obtained before the initiation of therapy, on day 4, after completion of therapy and 4 to 6 weeks after therapy. Specified laboratory tests were obtained. Of 14 patients receiving ceftizoxime 11 (79 per cent) and of 7 patients receiving cefamandole 7 (100 per cent) had negative cultures at the completion of therapy and 4 to 6 weeks later. No patient had any adverse reaction to ceftizoxime. Ceftizoxime is a safe and effective antibiotic agent when used as a single agent for complicated urinary tract infections. However, ceftizoxime is much more expensive than cefamandole therapy. Therefore, it is recommended that ceftizoxime be reserved for treatment of urinary tract infections stemming from pathogenic species resistant to the less expensive antimicrobials.     

Pharmacological treatment of bacterial infections of the respiratory tract

Bacterial infection of the respiratory tract is amongst the most common presentations to primary and secondary care. In addition to supportive care, the mainstay of pharmacotherapy is antibiotics. Antibiotic treatment of bacterial infections of the respiratory tract needs to consider patient factors such as age, comorbidities, location, previous antibiotic use, microbiological results and allergy. The emergence of multi-drug-resistant bacteria, partly a consequence of inappropriate antibiotic use, has both focussed the need for careful management of bacterial infection and presented a new therapeutic challenge. The choice of antibiotic for respiratory infections needs to be within national guidelines modified by local susceptibility profiles. Bacterial infections of the respiratory tract affect all levels of the airway tree and can be simply classified by their anatomical location, for example, epiglottitis, exacerbations of chronic obstructive pulmonary disease and bronchiectasis and pneumonia. As with all pharmacotherapy, alongside the benefit the potential side effects of the treatment needs to be considered. This is particularly important for the 6-month treatment of tuberculosis, which should only be managed by a specialist. The majority of bacterial infections of the respiratory tract respond well to therapy, but it is important to recognize that this remains a major cause of mortality.     

Pharmacological treatment of bacterial infections of the respiratory tract

Bacterial infection of the respiratory tract is amongst the most common presentations to primary and secondary care. In addition to supportive care, the mainstay of pharmacotherapy is antibiotics. Antibiotic treatment of bacterial infections of the respiratory tract needs to consider patient factors such as age, co-morbidities, location, previous antibiotic use, microbiological results and allergy. The emergence of multi-drug-resistant bacteria, partly a consequence of inappropriate antibiotic use, has both focussed the need for careful management of bacterial infection and presented a new therapeutic challenge. The choice of antibiotic for respiratory infections needs to be within national guidelines modified by local susceptibility profiles. Bacterial infections of the respiratory tract affect all levels of the airway tree and can be simply classified by their anatomical location for example: epiglottitis, exacerbations of chronic obstructive pulmonary disease and bronchiectasis and pneumonia. As with all pharmacotherapy, alongside the benefit the potential side effects of the treatment needs to be considered. This is particularly important for the 6-month treatment of tuberculosis, which should only be managed by a specialist. The majority of bacterial infections of the respiratory tract respond well to therapy, but it is important to recognize that this remains a major cause of mortality.     

Apalcillin treatment of complicated urinary tract infections

In an open, prospective clinical trial, we evaluated the safety and efficacy of apalcillin in the treatment of complicated urinary tract infection. 21 hospitalized adult patients received apalcillin 2 g IV Q8-12 h for 5-17 days. There were 8 upper tract and 13 lower tract infections. Of 25 functional or anatomic abnormalities of the GU tract among these patients, 9 (36%) were corrected during the study period. Effectiveness of apalcillin was determined by clinical and bacteriologic response. 16 (76.2%) patients had clinical cures, 4 (19.8%) had clinical improvement, and 1 (4.8%) had clinical failure. Based on 26 pretreatment isolates, there were 16 (61.5%) bacteriologic cures and 10 (38.5%) failures. Failures were due to 6 (23.1%) relapses, 2 (7.7%) superinfections, and 2 (7.7%) relapses with superinfection. Adverse reactions were mild, transient, and did not require discontinuation of treatment. Apalcillin appears to be a safe, although marginally effective single agent antibiotic for the treatment of complicated urinary tract infections.     

Clinical evaluation of sultamicillin in the treatment of urinary tract infections

Sultamicillin, a new semisynthetic oral beta-lactam antibiotic, was evaluated for its antibacteria susceptibility and clinical efficacy against urinary tract infection (UTI), and the following results were obtained. The sensitivity of sultamicillin (SBTPC) on 518 strains of clinical isolates from the urine were tested and compared to ampicillin (ABPC). S. aureus, S. epidermidis, Enterococcus sp., Streptococcus sp., E. coli, K. pneumoniae, K. oxytoca, P. mirabilis, M. morganii and Acinetobacter sp. showed high sensitivity to SBTPC. The antibacterial activity of SBTPC was superior to that of ABPC in most strains and especially more superior in beta-lactamase producing strains. The clinical effectiveness rate on a total of 15 patients with acute uncomplicated cystitis was 93.3% and the eradication rate of causative organisms was 93.3%. On 15 patients with chronic complicated UTI, the clinical effectiveness rate was 73.3% and eradication rate was 76.5%. Side effects (diarrhea) were observed in 3 cases, but this symptom was not severe and soon disappeared. Abnormal laboratory data due to the drug were not observed.     

Cinoxacin and nalidixic acid in treatment of urinary tract infections

Cinoxacin and nalidixic acid are urinary antibacterials which have a very low rate of resistance against the organisms found in uncomplicated urinary tract infections. Their use as an agent for the original “blind” treatment of these infections is worthy of consideration.     

Complications and treatment of urinary tract infections during pregnancy

Bacteriuria during pregnancy may result in serious complications, including development of acute pyelonephritis in the third trimester and premature labor. Because uninfected women commonly experience symptoms associated with urinary tract infections and many bacteriuric women are asymptomatic, all pregnant women should be screened by quantitative urine cultures. The goal of antimicrobial therapy is complete elimination of bacteria from the urinary tract. Major indications for complete urologic evaluation are failure of a patient with signs of acute upper-tract infection to improve on appropriate treatment and bacterial persistence after initial sterilization of the urine. Either problem may require surgical intervention.     

Complicated urinary tract infections

A complicated urinary tract infection is that which occurs in a patient with an anatomically abnormal urinary tract or significant medical or surgical comorbidities. Whereas this definition may not cover each and every situation, it does serve to encompass the great majority of these patients and guide their care. The definition is necessarily broad, to assure that these potentially complex patients are appropriately managed. Thus, complicated urinary tract infection describes a group of patients that usually need a prolonged course of antimicrobial therapy, with all its attendant morbidities, costs, and outcome differences.